营养状态和认知功能对PD患者日常生活能力的作用机制探索——基于中介效应和调节效应  

The mechanism of the function of nutritional status and cognitive function on Parkinson’s disease patients’ daily life ability-based on mediation effect and regulation effect

作　　者：韩敏 秦瑶 葛晓燕 韩红娟 崔靖 余红梅 HAN Min;QIN Yao;GE Xiao-yan;HAN Hong-juan;CUI Jing;YU Hong-mei(Department of Health Statistics,School of Public Health,Shanxi Medical University,Taiyuan,Shanxi 030001,China)

机构地区：[1]山西医科大学公共卫生学院卫生统计学教研室,山西太原030001 [2]锦州医科大学公共卫生学院卫生统计学教研室 [3]山西医科大学基础医学院数学教研室 [4]重大疾病风险评估山西省重点实验室

出　　处：《现代预防医学》2021年第21期4001-4005,4011,共6页Modern Preventive Medicine

基　　金：国家自然科学基金(81973154)。

摘　　要：目的探讨营养状态和认知功能对PD患者日常生活能力的影响机制。方法收集某院365例PD患者资料;采用简易营养评估量表(Mini Nutritional Assessment, MNA)、简易精神状态量表(Mini-Mental State Examination, MMSE)和统一帕金森病评分量表(Unified Parkinson’s Disease Rating Scale, UPDRSⅡ)分别评估PD患者的营养状态、认知功能和日常生活能力。采用Bootstrap法进行中介效应检验;采用协方差分析和简单效应分析检验调节效应。采用近似误差均方根(root-mean-square error of approximation, RMSEA)、赤池信息量准则(Akaike information criterion, AIC)、一致性赤池信息量准则(consistent Akaike information criterion, CAIC)和期望交叉验证指数(expected cross-validation index, ECVI)指标评估中介效应和调节效应模型的性能。结果中介效应结果:路径MNA→MMSE→UPDRSⅡ的中介效应无统计学意义Z=-1.83(P=0.067),β=-0.079, 95%CI(-0.164~0.006);路径MMSE→MNA→UPDRSⅡ的中介效应有统计学意义Z=-2.33(P<0.001),β=-0.106, 95%CI(-0.195~-0.017),中介效应占比为16.48%。调节效应结果:MMSE和MNA交互效应系数为β=-12.792(P=0.013),95%CI(-22.845~-2.740),t=-2.500。简单效应结果:潜在营养不良时,认知障碍组比认知正常组UPDRSⅡ评分平均高2.553分,95%CI为1.008~4.099;营养不良时,认知障碍组比认知正常组UPDRSⅡ评分平均高7.780分,95%CI为6.838~8.723。出现营养不良时,认知障碍与认知正常组的差值有统计学意义F=36.557(P<0.001),潜在营养不良时候,认知障碍与认知正常组的差值无统计学意义F=2.829(P>0.05)。结论 MMSE→MNA→UPDRSⅡ的中介路径成立,但是中介效应较弱;PD发展机制中,营养状态介导并调节了认知功能对PD患者日常生活能力的影响。Objective To investigate the effects of nutritional status and cognitive function on activities of daily living(ADL)in patients with Parkinson’s disease(PD).Methods Data of 365 PD patients in a hospital were collected.Mini Nutritional Assessment,Mini-Mental State Examination and Unified Parkinson’s Disease Rating Scale II were used to evaluate the nutritional status,cognitive function and activities of daily living of PD patients.Bootstrap method was used to test the mediating effect.And covariance analysis was used to test the moderating effect.Root-mean-square error of approximation,Akaike information criterion,consistent Akaike information criterion and expected cross-validation index were used to evaluate the performance of mediating effect and moderating effect models.Results The mediating effect of MNA→MMSE→UPDRS II was not statistically significant(Z=-1.83,P=0.067),β=-0.079,95%CI:-0.164 to 0.006.The mediating effect of MMSE→MNA→UPDRS II was statistically significant(Z=-2.33,P<0.001),β=-0.106,95%CI:-0.195 to-0.017,and the proportion of mediating effect was 16.48%.The result of the interaction coefficient of MMSE and MNA wasβ=-12.792(P=0.013),95%CI:-22.845 to-2.740,t=-2.500.Results of simple effect showed that,with potential malnutrition,UPDRS II scores were 2.553 points higher in the cognitively impaired group than in the cognitively normal group(95%CI:1.008 to 4.099).UPDRS II scores were 7.780 points higher in the cognitively impaired group than the cognitively normal group,with a 95%CI of 6.838 to 8.723.In the case of malnutrition,the difference between the cognitive impairment group and the cognitive normal group was statistically significant(F=36.557,P<0.001),while in the case of potential malnutrition,the difference between the cognitive impairment group and the cognitive normal group was not(F=2.829,P>0.05).Conclusion The mediation path of MMSE→MNA→UPDRS II is valid,but the mediation effect is weak.In the developmental mechanism of PD,nutritional status mediates and regulates the in

关 键 词：帕金森病 营养状态 认知功能 日常生活能力 调节效应 中介效应 

分 类 号：R742.5[医药卫生—神经病学与精神病学]